Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2025 12 15 1419 1419 EN Mahnaz Arian Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masoumeh Gharib Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Saeid Amel Jamehdar Antimicrobial Resistant Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Hesamoddin Hosseinjani Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Pourahmadazar Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Farshad Abedi Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 09 21 2025 10 07 Although varicella-zoster virus (VZV) infection is typically self-limiting in immunocompetent individuals, this case underscores its rare but fatal potential when complicated by appendicitis, hepatitis, and pneumonia. The rapid progression to septic shock in a healthy young adult makes this report novel and clinically significant. An 18-year-old previously healthy Iranian woman underwent an appendectomy, after which she developed diffuse varicella-like skin lesions. Polymerase chain reaction of peripheral blood confirmed VZV viremia. During hospitalization, she developed pneumonia, hepatitis, and septic shock requiring intensive care. Despite aggressive treatment, including intravenous acyclovir, broad-spectrum antibiotics, and hemodynamic support, she died from multiorgan failure seven days after admission. This case demonstrates that even common, typically benign infections (e.g., chickenpox) and routine surgical conditions (e.g., appendicitis) can culminate in fatal systemic complications in immunocompetent patients. Clinicians should maintain a high index of suspicion for atypical VZV presentations in adults, as early antiviral therapy may improve outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1419